The extent of what innovation can enable in our everyday experiences has created a culture where constant technological advancement is both the norm and the expectation. Profits are driven by consumers’ growing anticipation for products and services that address needs instantaneously, and evolve in technological capabilities continuously. Tomorrow there will inevitably be a new version of that product or service that is better, faster and smarter than its predecessor (your smartphone, for example).
All of this is contributing to the growth of healthcare consumerism. Meanwhile, the industry faces increasing challenges keeping a complex population of consumers engaged in their health.
Rob Havasy, senior director of thought advisory at HIMSS, has worked in the world of connected health for many years. Before joining HIMSS, he designed and implemented systems that gathered and integrated patient-generated health data into clinical workflows.
“There is still a strong undercurrent when healthcare thinks about consumerism and the role that individuals play,” Havasy said. “Some people believe that the consumption of healthcare services is one of the factors leading to its high costs, and if we give people more choices, they will make better choices. Hopefully, better choices mean consuming less care, driving costs down.
“On the other side, economic circumstances can limit an individual’s ability to make informed choices, especially while chronic disease or other health conditions are consuming their lives.”
Rod Piechowski, vice president of thought advisory and cybersecurity expert at HIMSS, has spent more than a decade working in the health IT industry. Like Havasy, he sees both sides of the equation.
Every year America spends about $5,000 more per person on healthcare than other wealthy countries do.
“We’re still trying to get more transparency around pricing,” said Piechowski. “There’s an assumption that consumers only care about the lowest price, but having choice isn’t always about price. You want value, you want the best product, the best outcome, for the best price. Unfortunately, if all of the options are unaffordable, it’s not really a choice.”
The move toward new payment models in the U.S. is part of a longer-term effort to cut back on costs, Piechowski added. “It will be a benefit to the payer when they can save on this. They’re a stakeholder in this as well, and when their populations have better health for better costs, better experiences … it’s another important perspective to consider. They will play a big role in whether the consumerization movement takes off and it will be in their benefit to see that it does,” said Piechowski. “These competing perspectives are going to be at the root of redefining how healthcare is experienced, provided, paid for, and whether or not you get better outcomes.”
Empowering Patients by Expanding Options
One of the many challenges on the healthcare horizon is the impending silver tsunami. The U.S. Census Bureau projects that in 2030 for the first year in history, older people will outnumber children, and one out of every five individuals will be of retirement age.
The good news is that healthcare consumerism is already providing innovative solutions to support aging populations. Now when an individual’s health declines, instead of having to relocate to a long-term care facility right away, individuals can leverage virtual solutions to enjoy increased independence. Family members can also provide support with technology and home care professionals can be hired to help support care in whichever ways technology can’t. It’s a transformative change for elderly individuals, who now have more options to experience aging in the comfort of their home.
“The home healthcare market is bringing care to people where they are, when they need it and when they’re ready to engage,” said Havasy. “It’s a ‘just in time’ care model that’s ripe for growth and expansion.”
Bringing care delivery back to the home is a convenient option to improve population health in general, as the time spent treating non-life threatening illnesses in a hospital can be significantly reduced. By providing virtual resources and televisit options for the recovery process, one can spend less time in a hospital bed and more time recovering at home: a benefit to both the patient and the provider.
Healthcare consumerism is also expanding access to care through telehealth for many people living in rural America or facing other obstacles that can lead to missed doctor’s appointments. But despite recent advancements in telehealth legislation, not all providers are buying into virtual visits. One survey found that physicians show far less interest in telehealth than patients – with just 14 percent offering telehealth services and only 18 percent planning to offer televisits in the next two years. The survey indicated that physician concerns are linked to challenges with reimbursement, licensing requirements, and security issues.
“What they’re failing to acknowledge is the patient perspective. That telemedicine interaction was probably more convenient for the patient, and it likely cost the system a little bit less overall,” Havasy pointed out. “Why not change something if the outcomes are just as good and the option is more convenient for the patient?
“That’s one of the ways people need to start thinking about consumers: if you can do the same thing faster and easier – even if the costs and outcomes are the same, in many cases, faster and easier will win. Healthcare will have to be the one to yield, because consumers won’t.”
Increasing Information and the Individual Impact
Consumers. Individuals. Patients. Maybe it’s time to revamp the language we use when we talk about consumers of health, or individuals, Havasy suggested. “For example, am I always a patient because I manage a chronic condition, or am I only a patient during the 60 minutes a year I spend with a doctor? What am I in between while I manage my condition, but don’t interact with doctors?
“Do we need fifty English words for different degrees of patient-hood? I doubt it, but we need something more than we currently have,” said Havasy. A 2018 survey on consumer perspectives on patient experience showed that out of 2,000 respondents, only 35 percent of patients viewed themselves as customers, or consumers.
Healthcare, at its heart, historically has been a relationship-based profession driven by a passion for serving people. Could healthcare consumerism threaten the sacred bond between physicians and patients?
During a time where individuals are seeking more ownership of their healthcare decision-making, a surplus of medical misinformation is certainly causing some tension in the relationship. As healthcare battles major public health threats resulting from the spread of misinformation, some physicians feel that giving patients more power in decision-making could be detrimental to public health.
“While physicians have a duty to care and to heal, they want to respect the individual as an autonomous moral agent capable of making their own decisions,” said Piechowski. “They don’t want to inflict decisions upon people that may not be aligned with their moral foundation. If the patient thinks they want a different kind of care, and the physician knows that it is not what’s best for the patient, or won’t result in a positive outcome, there’s an ethical dilemma there on the part of the decision.
“Are they then just acting at the behest of the patient and providing a service that’s requested?” said Piechowski. “Or are they now duty-bound to provide ethical advice and care that is actually going to result in a better outcome, a better life, for that patient?”
“The idea that everything can be consumerized or that people will always make good decisions is a tough one to swallow for many people,” said Havasy. “What we’ve discovered about connected health over the last decade is that even when we get better at building dashboards and presenting data at the right moment in time so it is actionable, we still have trouble adjusting long-term health behaviors,” said Havasy.
“While a wearable might prompt you to take a walk, it’s not very useful if that notification comes in while you’re on a conference call,” said Havasy. “It needs to be context aware, and it shouldn’t be that hard for it to synch with my schedule and know when I have free time for physical activity.”
“We’re still at the foothills of a very tall mountain when it comes to our ability to collect and analyze data, and turn that into information,” said Piechowski. “Raw data doesn’t really mean anything unless you know how to analyze it and what you’re looking for.” Getting individuals the information needed to make good decisions independently is still a long way off, Piechowski said.
“To influence long-term behavior change, individuals need the right information, at the right moment, in the right context, when they have the ability to act on it,” Havasy added.
“As long as healthcare is viewed as a transactional interaction that a third party generally pays for, it’s going to be much more challenging to get that longer term engagement, motivation and action required to influence better outcomes,” Piechowski said. “There’s too much happening behind the scenes that either artificially constrains people, or is just nearly impossible to understand – unless you’re a healthcare economist – in how it is affecting decisions.”
Havasy and Piechowski agreed that to reap the true benefits of healthcare consumerism, society will need to adapt along with the market – and that won’t happen overnight. Much work remains to improve information asymmetry across the health ecosystem in ways that will influence individual’s long-term behavior and improve outcomes.
The road to health reformation is a long one, but we’re getting closer.
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